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Age-related differences in factors associated with cervical spine injuries in children
Julie C Leonard1, David M Jaffe, Cody S Olsen
1The Department of Pediatrics, Division of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis Children's Hospital, St. Louis, MO.
Insights
Pediatric Emergency Care Applied Research Network (PECARN) identified age-specific risk factors for cervical spine injuries (CSIs) in children. While the original model is supported, subtle variations in younger age groups warrant further study for improved pediatric trauma care.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Pediatric Orthopedics
Background:
- The Pediatric Emergency Care Applied Research Network (PECARN) previously established risk factors for cervical spine injuries (CSIs) in children.
- Age-related variations in injury mechanisms and anatomical maturation necessitate exploring these factors in distinct pediatric age subgroups.
Purpose of the Study:
- To investigate and identify specific risk factors associated with cervical spine injuries (CSIs) in different age subgroups of children within the PECARN cohort.
- To compare the efficacy of age-specific risk factor models against the original PECARN model for pediatric CSI detection.
Main Methods:
- An age-stratified case-control analysis was conducted on children under 16 years old presenting with blunt trauma to 17 PECARN hospitals.
- Data from children with CSIs and a control group of CSI-free children were analyzed using multivariable logistic regression across three age groups: <2, 2-7, and 8-15 years.
- Sensitivity and specificity of age-specific models were compared to the original PECARN model, which included altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, predisposing conditions, diving, and high-risk motor vehicle crashes (MVCs).
Main Results:
- Focal neurologic deficits and high-risk MVCs were significant predictors of CSIs across all age groups.
- Specific factors varied by age: altered mental status, neck pain, and torticollis were associated with CSIs in the 2-7 year group, while altered mental status, neck pain, and diving were noted in the 8-15 year group.
- Age-specific models demonstrated comparable sensitivity to the original model in older children but lower sensitivity and higher specificity in the youngest age group (<2 years).
Conclusions:
- The original PECARN model for identifying cervical spine injuries in children remains supported by this analysis.
- Subtle age-related variations in risk factors for pediatric CSIs were identified, suggesting a need for further investigation.
- Refining age-specific risk assessment may enhance the accuracy of diagnosing CSIs in pediatric trauma patients.
Objectives:
The Pediatric Emergency Care Applied Research Network (PECARN) investigators previously identified risk factors associated with cervical spine injuries (CSIs) in children. Anatomic maturation and age-related variation in mechanisms of injury suggested the need to explore factors separately for younger versus older children. The purpose of this substudy was to investigate CSI risk factors in age subgroups within the PECARN study cohort.
Methods:
This was an age-stratified case-control analysis of children younger than 16 years presenting to 17 PECARN hospitals following blunt trauma between January 1, 2000 and December 31, 2004. Data were abstracted for children with CSIs and randomly selected CSI-free children. Age-stratified multivariable logistic regression was performed to identify factors associated with CSI within three age groups: younger than 2, 2 to 7, and 8 to 15 years. Sensitivity and specificity for CSI were estimated for both the age-specific and original (altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, predisposing conditions, diving, and high-risk motor vehicle crash [MVC]) models.
Results:
Among 540 children with CSIs, 27 were younger than 2 years, 140 were 2 to 7 years, and 373 were 8 to 15 years. Focal neurologic deficits and high-risk MVC were associated with CSIs in all age-specific models. Other age-specific factors included the following: younger than 2 years, none; 2 to 7 years, altered mental status, neck pain, torticollis; and 8 to 15 years, altered mental status, neck pain, diving. Age-specific models had comparable sensitivity to the original model among the older groups, but had lower sensitivity and higher specificity among the youngest children.
Conclusions:
While this analysis supports the original PECARN model for CSI, there were subtle age variations in factors associated with CSIs in children that warrant future investigation.
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